Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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Review Case Reports
Amphotericin B lipid complex (ABLC)-associated hypertension: case report and review.
Amphotericin B (AmB) continues to be the mainstay of therapy for serious fungal infections, despite its relatively toxic side-effect profile. Lipid preparations of the medication have been marketed in the past few years in an attempt to reduce some of these side effects, especially nephrotoxicity. ⋯ We report here the first case of severe hypertension associated with the infusion of AmB lipid complex (ABLC) in a patient with multiple intraperitoneal and urinary fungal pathogens. We also provide a brief review of the previously reported cases of hypertension associated with the deoxycholate formulation of AmB.
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Comment Letter Case Reports
Abdominal pain and fever-an unusual presentation of meningococcemia.
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Review Case Reports
Life-threatening Mycoplasma hominis mediastinitis.
Mycoplasma hominis infections are easily missed because conventional methods for bacterial detection may fail. Here, 8 cases of septic mediastinitis due to M. hominis are reported and reviewed in the context of previously reported cases of mediastinitis, sternum wound infection, pleuritis, or pericarditis caused by M. hominis. All 8 patients had a predisposing initial condition related to poor cardiorespiratory function, aspiration, or complications related to coronary artery surgery or other thoracic surgeries. ⋯ M. hominis infections may also present as mild sternum wound infection or as chronic local pericarditis or pleuritis without septic mediastinitis. Treatment includes surgical drainage and debridement. Antibiotics effective against M. hominis should be considered when treating mediastinitis of unknown etiology.
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Multicenter Study
Clinical significance of nephrotoxicity in patients treated with amphotericin B for suspected or proven aspergillosis.
The records of 239 immunosuppressed patients receiving amphotericin B for suspected or proven aspergillosis were reviewed to determine rates of nephrotoxicity, dialysis, and fatality. The mean and median durations of treatment were 20.4 and 15.0 days, respectively. ⋯ Use of hemodialysis (HR, 3. 089; P<.001), duration of amphotericin B use (HR, 1.03 per day; P=. 015), and use of nephrotoxic agents (HR, 1.96; P=.017) were associated with greater risk of death, whereas patients undergoing solid organ transplantation were at lowest risk (HR, 0.46; P=.002). These data indicate that elevated creatinine levels during amphotericin B treatment are associated with a substantial risk for hemodialysis and a higher mortality rate, but the risks vary in different patient groups.